복강경 신적출술 시 Hem-o-lok Clip을 이용한 신정맥 결찰술; Endo-GIA Stapler와 비교
Comparison of Endo-GIA Stapler and Hem-o-lok Clip for the Vascular Control during Laparoscopic Nephrectomy
김범수, 김기호, 권태균, 조덕현, 김현태, 유은상,
소속 상세정보
김범수 ( Kim Bum-Soo )
경북대학교 의과대학 비뇨기과학교실
김기호 ( Kim Ki-Ho )
경북대학교 의과대학 비뇨기과학교실
권태균 ( Kwon Tae-Gyun )
경북대학교 의과대학 비뇨기과학교실
조덕현 ( Cho Deok-Hyun )
경북대학교 의과대학 비뇨기과학교실
김현태 ( Kim Hyun-Tae )
경북대학교 의과대학 비뇨기과학교실
유은상 ( Yoo Eun-Sang )
경북대학교 의과대학 비뇨기과학교실
KMID : 0358320070480020120
Abstract
Purpose: Vascular control is an important step during a laparoscopic nephrectomy. The application of an endovascular gastrointestinal anastomosis(endo-GIA) stapler has become a standard method for control of the renal vein during a laparoscopic nephrectomy. However, the device is expensive, and malfunctions resulting in significant complications have been reported. Recently, another stapling device(Hem-o-lok clip) has been developed and used for the management of the renal hilum during a laparoscopic nephrectomy. Herein, the uses of an endo-GIA stapler and Hem-o-lok clip were compared.
Materials & Methods: Between August 2002 and April 2006, 288 laparoscopic nephrectomies(68 simple, 115 radical, 70 live donor nephrectomies, 35 nephroureterectomies) were performed via transperitoneal (n= 211), retroperitoneal(n=11) or hand-assisted(n=66) approaches. All patients were evaluated by detailed history taking, physical examination and laboratory investigations. Renal vein control was achieved solely using either an endo-GIA stapler(n=146) or Hem-o-lok clip(n=142), and renal artery control was obtained using Hem-o-lok clips alone or in combination with metal clips. The technical difficulty in obtaining vascular control, and the safety, cost, transfusion requirement and clinical outcomes were evaluated.
Results: There were no statistically differences in the mean operation times and hospitalization stays between the two groups. No perioperative or postoperative complications occurred in the Hem-o-lok group. In contrast, two cases of inferior vena caval injury requiring open conversion, and one of postoperative rebleeding resulting in a reoperation, occurred in the endo-GIA group. Postoperative transfusions were required 17 and 7 cases in the endo-GIA and Hem-o-lok groups, respectively.
Conclusion: The Hem-o-lok technique is easy, safe and cost-effective compared to the endo-GIA stapler for vascular control during a laparoscopic nephrectomy. (Korean J Urol 2007;48:120-124)
키워드
Nephrectomy;Laparoscopy;Renal veins;Surgical clip
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